GRA NUTRI CARE

MR. G MVULA
CALL: +260973335873
Public Health Nutrition
HPCZ - LEX
 Nutrition care process

• The Nutrition Care Process is a systematic method to providing high-

quality nutrition care.
• it is designed to improve :
 consistency and quality of individualized care for patients/clients and
 predictability of the patient/client outcomes.
• It is not intended to standardize nutrition care for each patient/client. The
goal of NCP is to standardize a process for providing nutrition care.
 NCP Cont’d
Four steps (ADIME):
• Nutrition Assessment
• Nutrition Diagnosis
• Nutrition Intervention
• Nutrition Monitoring/Evaluation
NCP Cont’d
 Nutrition Assessment
Nutrition Assessment (NA)
• is the first step in nutrition care process (NCP)
• Obtain adequate information in order to identify nutrition-related
problems
• Make decisions about the nature and cause of nutrition related
problems
 Nutrition Assessment Cont’d

Critical Thinking Skills

• Determining appropriate data to collect
• Determining the need for additional information
• Selecting appropriate assessment tools and procedures
• Applying the assessment tools in valid and reliable ways
• Distinguishing relevant from irrelevant data
• Distinguishing important from unimportant data
 Nutrition Assessment Cont’d

Results of Nutrition Assessment

• Leads to appropriate initial determination that a nutrition
diagnosis/problem exists
• If a nutrition problem is not identified, further information or testing
may be necessary to make a determination
 Nutrition Assessment Cont’d

Results of Nutrition Assessment/Reassessment

The RDN will determine;
• If a nutrition diagnosis/problem exists
• The plan for continuation of care, specifically:
 Progression through the NCP
 Need for additional information/testing
 Discharge from nutrition care
 Nutrition Assessment Cont’d
Domains (Categories)
1. Food/Nutrition Related History
2. Anthropometric Measurements
3. Biochemical Data, Medical Tests, Procedures
4. Nutrition-Focused Physical Findings
5. Client History
 Nutrition Assessment Cont’d

Data Sources and Tools

• Screening or referral form
• Patient interview
• Medical or health records
• Consultation with caregivers and family
• Community based surveys
• Statistical reports, administrative data, epidemiological studies
 Nutrition Diagnosis

• Diagnosis is the act of identifying a disease or condition from it’s

signs and symptoms
• Diagnosis is the second step in the NCP links nutrition assessment
and intervention.
• The dietician identifies and labels a specific nutrition diagnosis
that the dietician is responsible for treating.
• Standardized language for the NCP has been developed to be
used in identifying a nutrition diagnosis
 Nutrition Diagnosis Cont’d

PES Statement
• The nutrition diagnosis or nutrition problem is
• summarized into a structured sentence called
• Nutrition diagnosis statement
OR
• PES Statement
 PES Statement

This statement has 3 distinct components:

• P (Problem)
• E (Etiology)
• S (Signs and Symptoms)
 This information is obtained during the nutrition assessment phase
of the Nutrition Care Process
 PES Statement: Purpose

• PES statements are designed to identify a nutrition diagnosis that is

specific and measurable.
• P: Problem or Diagnosis - What is the nutrition problem that the
intervention will address?
• To improve your diagnosis, ask yourself: Can the diagnosis be
corrected or improved during your time with the patient/client?
 PES Statement Cont’d

• E: Etiology - What is the underlying cause of the problem?

• To help identify the etiology, ask yourself: Is there an intervention that
can address the etiology?
• S: Signs/Symptoms - What is the evidence to support the nutrition
diagnosis?
• To help identify signs/Symptoms, ask yourself: Are the signs/symptoms
specific and measurable? Can the signs/symptoms help identify when the
problem is resolved or improved?
 PES Statement Cont’d
This statement has a distinct format:
• Problem related to Etiology as evidenced by signs and Symptoms
Evaluating PES statement
• P (Problem): Can the RDN resolve or improve the nutrition diagnosis?
Consider the “intake” nutrition diagnosis as the one more specific to the
role of the RDN.
• E (Etiology): Determine if this is the “root cause” for the problem. If
addressing the etiology will not resolve the problem, can the RDN
intervention lessen the signs and symptoms?
• S (Signs and Symptoms): Will measuring the signs and symptoms
indicate if the problem is resolved or improved? Are the signs and
symptoms specific enough that the RDN can monitor and document
resolution or improvement of the nutrition diagnosis?
 Examples of PES statement

• Excessive Fat Intake related to limited access to healthful options – frequent

consumption of high-fat, fast-food meals as evidenced by serum cholesterol level
of 230 mg/dL and patient report of 10 meals per week of hamburgers and fries
• Excessive Energy Intake related to unchanged dietary intake and restricted
mobility while fracture heals as evidenced by 5lb weight gain during last 3 weeks
due to patient report of consumption of 500 kcal/day more than estimated needs
• Swallowing Difficulty related to post stroke complications as evidenced by results
of swallowing tests and reports of choking during mealtimes
• Obesity related to history of excessive energy intake as evidenced by BMI of
40.1kg/m² and food nutrition history obtained.
 Nutrition Diagnosis Etiology

• Identifying the etiology leads to selection of the nutrition

intervention aimed at resolving the underlying cause of the nutrition
problem
• If the intervention cannot be aimed at resolving the underlying
cause, as is the case in Physiologic-Metabolic etiologies, then the
nutrition intervention is targeted at minimizing the signs/symptoms
of the nutrition problem
 Nutrition Diagnosis Etiology Cont’d

Etiologies are grouped by the type of cause or contributing risk factor. See
Nutrition Diagnosis Etiology Matrix for definitions.
• Beliefs-Attitudes
• Cultural
• Knowledge
• Physical Function
• Physiologic
• Social-Personal
• Treatment
 Nutrition Diagnostic Terminology
Three general domains
• Intake
 Excessive or Inadequate intake compared to requirements (actual
or estimated)
• Clinical
 Medical or physical conditions that are outside normal
• Behavioral-Environmental
 Relate to knowledge, attitudes, beliefs, physical environment,
access to food, or food safety
 Nutrition Intervention

• Nutrition intervention is purposeful planned actions intended to

positively change a nutrition related behavior, environmental
condition, or aspect of health status.
• Directed to the etiology or cause of the problem identified in the
PES statement
• Sometimes the intervention must be directed toward the signs and
symptoms if the RDN cannot impact the etiology
 Nutrition Intervention

Two interrelated components

• Planning
• Implementation
 Nutrition Intervention Cont’d

Planning:
• Prioritize the nutrition diagnoses
• Review practice guidelines (EAL) and policies
• Confer with the patient (and others)
• Set goals and determine expected outcomes
• Defining the specific nutrition intervention strategy
• Define time and frequency of care
 Nutrition Intervention Cont’d

Implementation
• Communicate the plan of care
• Carry out the plan of care
• Continue data collection
Monitor and Evaluate
• Follow‐up and verify the implementation
• Revise nutrition intervention strategy if needed
 Nutrition Intervention Cont’d

Four Domains
• Food and/or Nutrient Delivery
• Nutrition Education
• Nutrition Counseling
• Coordination of Nutrition Care
 Nutrition Intervention Cont’d
Use of Nutrition Interventions Based on Practice Setting

• Food and/or Nutrient Delivery: • Nutrition Counseling:

 institutional settings (hospitals,  outpatient/non institutionalized settings
long‐term care)  private practice
 home care  community
• Nutrition Education‐Content: • Coordination of Nutrition Care:
 institutionalized settings  all practice settings
• Nutrition Education‐Application:
 outpatient/non institutionalized settings
 private practice
 community
 Nutrition Monitoring & Evaluation

Critical thinking skills for Nutrition Monitoring &Evaluation:

• Selecting appropriate indicators/measures
• Using appropriate criteria (previous status, nutrition intervention goals, or
reference standards) for comparison
• Defining where patient/client is now in terms of expected outcome
• Explaining variance from expected outcomes
• Identifying factors that help/hinder progress
• Deciding between discharge or continuation of nutrition care
 Nutrition Monitoring & Evaluation Cont’d

• Determines whether the patient is meeting the nutrition intervention goals or

desired outcomes
• A nutrition reassessment is needed to identify whether the nutrition-related problem
still exists and evaluate the progress made toward resolving the problem.
• Determines whether the patient is meeting the nutrition intervention goals or
desired outcomes
• A nutrition reassessment is needed to identify whether the nutrition-related problem
still exists and evaluate the progress made toward resolving the problem.
KEEP THE FOCUS AS YOU STAY FOCUSED

By: Gracious Mvula

Thank you !!